WO2004073524A1 - Dispositif d'incision pliable - Google Patents

Dispositif d'incision pliable Download PDF

Info

Publication number
WO2004073524A1
WO2004073524A1 PCT/US2004/005168 US2004005168W WO2004073524A1 WO 2004073524 A1 WO2004073524 A1 WO 2004073524A1 US 2004005168 W US2004005168 W US 2004005168W WO 2004073524 A1 WO2004073524 A1 WO 2004073524A1
Authority
WO
WIPO (PCT)
Prior art keywords
cutting
loop
probe
tissue
cutting loop
Prior art date
Application number
PCT/US2004/005168
Other languages
English (en)
Inventor
Huddee Jacob Ho
Roberta Lee
Samuel E. Zuckswert
Stan Conston
Ronald Yamamoto
Don Allen
Original Assignee
Manoa Medical, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Manoa Medical, Inc. filed Critical Manoa Medical, Inc.
Priority to DE602004022514T priority Critical patent/DE602004022514D1/de
Priority to JP2006503767A priority patent/JP2006518646A/ja
Priority to AT04713390T priority patent/ATE439089T1/de
Priority to EP04713390A priority patent/EP1599139B1/fr
Publication of WO2004073524A1 publication Critical patent/WO2004073524A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A61B10/0266—Pointed or sharp biopsy instruments means for severing sample
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/04—Endoscopic instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32056—Surgical snare instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1407—Loop
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/144—Wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters

Definitions

  • the present invention relates generally to devices and methods for cutting soft tissue. More specifically, devices and methods for a minimally invasive procedure for cutting or excising a volume of soft tissue such as a biopsy or a therapeutic excision of cancer are disclosed.
  • Minimally invasive procedures have instigated a need for refinement in surgical devices that can function within confined spaces, particularly in soft tissue, such as breast tissue.
  • Devices that are typically used during open surgical procedures i.e., scalpel, scissors, electrosurgical "pencil” electrode
  • scalpel, scissors, electrosurgical "pencil” electrode are often not adaptable for use in a minimally invasive procedure.
  • the actual procedure cannot be directly visualized as the skin incision is typically just large enough to insert the device.
  • Minimally invasive procedures are often guided by medical imaging or by video camera as is often used in laparoscopy. In the breast, mammography, ultrasound and magnetic resonance imaging (MRI) are used to guide minimally invasive procedures.
  • MRI magnetic resonance imaging
  • Open surgical biopsy removes lesions of variable size and may include extensions of the lesion but often an excessive amount of normal breast tissue is included in the specimen leading to a poor cosmetic result.
  • open surgical biopsy typically requires a significant skin incision resulting in a longer, permanent scar.
  • a diseased duct and/or disease in Cooper's ligament are not detectable either by direct vision or by palpation during an open surgical procedure.
  • the main cancerous mass may be excised, but a diseased duct filled with cancerous cells and/or diseased Cooper's ligament is often not appreciated during the procedure and unintentionally not included in the excision.
  • Axial ductal ultrasound is a method of ultrasound scanning of the breast that demonstrates the internal anatomy of the breast.
  • the ducts and lobes of the breast are identified resulting in visualization of not only a lesion, but also diseased duct(s) and extension into Cooper's ligament.
  • Multifocal cancers or additional cancers associated with the diseased duct may also be visualized. Therefore, the entire disease process (i.e., the lesion and extensions of the lesion within the breast) is visualized and can be removed under direct, real-time ultrasound guidance.
  • a device and method for a minimally invasive procedure that excises lesions of variable size within a volume of tissue from a breast or other soft tissue. More specifically, there is a need for a device and method to excise a disease process within a breast that includes not only the main focus of the disease (i.e., a lesion or a mass) but also the duct or ducts that are also affected and any other anatomic extension of the disease process (e.g., growth into Cooper's ligament). Preferably the procedure is guided using medical imaging.
  • the device for excising a volume of soft tissue generally includes a probe containing a cutting loop.
  • the probe has a length defining a probe axis while the cutting loop has a loop height defining a loop axis.
  • the loop is preferably made from a metal or metal alloy having superelastic properties or shape memory capability such that the angle between the loop axis relative to the probe axis can be configured to one or more positions.
  • the loop is in a penetrating configuration where the loop axis is configured to align at an angle that is generally approximately 180 degrees relative to the probe axis to facilitate ease of penetration.
  • the loop After the probe is positioned in the desired location, the loop preferably moves to a cutting configuration such that the angle between the loop axis and the probe axis is generally approximately 90 degrees.
  • the loop exits the probe through angled exits which determine the angle of the loop axis relative to the probe axis when the loop is in the cutting configuration.
  • the loop may be manually or mechanically forced into the penetrating configuration and held in place. When released, the loop moves to the cutting configuration.
  • the change in angle of the loop axis relative to the probe axis is facilitated by the superelastic property or the shape memory capability of the metal or metal alloy used to configure the loop.
  • the superelastic property allows the loop to change configuration without developing a kink or permanent deformity in the loop.
  • the loop may have one or more sharpened edges.
  • the loop may be energized such as with radio frequency energy and/or the loop may be configured to oscillate along a predetermined or variable distance, direction and/or frequency.
  • the loop shape and/or sized may be fixed or variable by adjusting the width and/or height of the loop.
  • a method for cutting a volume of soft tissue generally includes scanning the soft tissue with an imaging device and determining the volume of soft tissue to be excised.
  • the volume of soft tissue contains at least one of a lesion, a duct or ducts, a Cooper's ligament and a lobe or part of a lobe.
  • the probe is positioned in the soft tissue adjacent to the targeted volume of soft tissue with the loop in the penetrating configuration. Energy such as radio frequency energy may be used to facilitate tissue penetration.
  • the loop is released from the penetrating configuration and moved to the cutting configuration. After the loop is in the cutting configuration, the probe is advanced or retracted to move the loop creating a circumferential cut around the volume of soft tissue.
  • the loop may be expanded and/or retracted in width and/or height to accommodate variations in the desired volume of soft tissue being excised.
  • the loop may be energized from an external energy source (e.g., radio frequency energy) and/or may oscillate. Oscillation of the loop is typically independent of the probe advancement or retraction and may be in one of several directions.
  • an external energy source e.g., radio frequency energy
  • Oscillation of the loop is typically independent of the probe advancement or retraction and may be in one of several directions.
  • the loop is retracted into the probe or, in an alternative, the loop is mechanically forced into the penetrating configuration to complete the cutting process.
  • the procedure may be guided using an imaging device.
  • the imaging device may be external to the patient or the imaging device may be incorporated into the probe.
  • FIGS. 1A and IB are perspective side views of an exemplary embodiment of a cutting device with a bendable loop in a penetrating and a cutting configuration, respectively.
  • FIGS. 1C and ID are cross-sectional views of alternative embodiments of the cutting device.
  • FIGS. 2 A and 2B are perspective views of alternative exemplary embodiments of the cutting device with a bendable loop.
  • FIGS. 3A-3F are perspective views of further alternative exemplary embodiments of the cutting device with a bendable loop.
  • FIGS. 4 A and 4B are perspective views illustrating exemplary configurations of the loop in the cutting configuration.
  • FIG. 5 is a perspective view of yet another alternative exemplary embodiment of the cutting device with a bendable loop.
  • FIG. 6 is a perspective view illustrating an exemplary configuration of an imaging device incorporated into the probe.
  • FIGS. 7A and 7B are perspective views of an alternative exemplary embodiment of the cutting device with a bendable loop.
  • FIGS. 8A-8D are schematics illustrating the cutting device used in conjunction with an imaging device to cut a volume of soft tissue.
  • FIG. 9 is a flowchart illustrating an imaging and cutting process employing the bendable cutting device. DESCRIPTION OF SPECIFIC EMBODIMENTS
  • FIGS. 1 A and IB are perspective views of an exemplary embodiment of a cutting device 100 with a bendable loop 34 in a retracted and an extended position, respectively.
  • the cutting device 100 generally comprises a probe 20 and a handle 40.
  • the probe 20 defines a probe axis 28 between a proximal end 24 and a distal end 22.
  • the loop channels 26 may contain an electrode 30.
  • the electrode 30 terminates in electrode ends 32 in the proximal end 24 or the handle 40, as shown in FIG. 1A.
  • the electrode 30 extends out of the cutting device 100 at the angled exits 44 such that the electrode 30 between the angled exits 44 creates the bendable loop 34.
  • extension of the loop 34 out of the angled exits 44 defines a loop height 46.
  • a loop width 48 is determined by an angle ⁇ between the angled exits 44.
  • the angle ⁇ is predetermined although the angle ⁇ may be variable.
  • the angle ⁇ defines a loop width 48 that is larger than the loop width 48 in the alternative embodiment illustrated in FIG. ID.
  • at least one of the loop channels 26 is a rotatable tube that terminates at the angled exit 44. Rotating one or more rotatable tubes varies the angle ⁇ which varies the loop width 48.
  • the probe 20 and handle 40 may be configured from any number of materials including metals, metal alloys, ceramics and/or plastics.
  • the probe 20 and handle 40 may be configured as a single unit or as one or more separate units that are fastened together.
  • the electrode 30 is made from a nickel titanium alloy (nitinol) with shape memory or superelastic property although any other suitable metal or metal alloy with shape memory or superelastic properties may be employed.
  • FIG. IB illustrates the loop 34 in a cutting configuration.
  • At least one of the angled exits 44 and/or the shape memory properties of the electrode 30 facilitate in configuring the loop 34 to the cutting configuration .
  • the angled exits 44 determine a loop axis 36 defined by the loop 34 relative to the probe axis 28.
  • a loop angle ⁇ is defined between the probe axis 28 and the loop axis 36.
  • the loop 34 assumes the cutting configuration when the loop 34 is at least partially extended through the angled exits 44.
  • the angled exits 44 configure the loop 34 such that the loop angle ⁇ is generally 90 degrees although the loop angle ⁇ may be less than or greater than 90 degrees as in the embodiments illustrated in FIGS.
  • the angled exits 44 may be configured such that the loop angle ⁇ is greater than 90 degrees, as illustrated in FIG. 4A. ' In an alternative embodiment, the angled exits 44 may be configured such that the loop angle ⁇ is less than 90 degrees, as illustrated in FIG. 4B.
  • the loop 34 is preformed to a predetermined cutting configuration preferably before the electrode 30 is assembled into the cutting device 100.
  • the process of preforming a loop to the predetermined configuration is well known to those skilled in the art.
  • the electrode 30 can be positioned and maintained such that the loop 34 is in the predetermined cutting configuration and heated to a specified temperature for a predetermined length of time followed by rapid cooling. The temperature and length of time may be varied according to the type of material used for the electrode 30.
  • the loop 34 is preformed such that the loop angle ⁇ is approximately 90 degrees.
  • the loop 34 is shown in a penetrating configuration where the loop 34 is positioned such that the loop angle ⁇ is approximately 180 degrees.
  • a groove 38 located at or near the distal end 22 of the probe 20 holds the loop 34 in the penetrating configuration.
  • the loop 34 which is in the cutting configuration when at least partially extended (as shown in FIG. IB), may be manually or mechanically positioned into the penetrating configuration.
  • the electrode 30 is made of a material having superelastic properties (e.g., nitinol) to allow the loop 34 to be positioned into the penetrating configuration without creating a permanent kink or distortion in the electrode 30.
  • the penetrating configuration is maintained by placement of the loop 34 into the groove 38, followed by slight retraction of the loop 34. The slight retraction keeps the loop 34 tightly held within the groove 38.
  • a loop locking mechanism may be provided on the handle 40 to secure the loop 34 in the penetrating configuration.
  • a loop controller 42 located on the handle 40 controls extension and retraction of the loop 34. Maintaining the loop 34 in the penetrating configuration enhances insertion of the probe 20 into soft tissue by creating a more linear profile to the probe 20. Keeping the partially extended loop 34 external to the probe 20 and held within the groove 38 allows for a smaller diameter probe 20.
  • the loop 34 may be manually or mechanically positioned by the methods described herein such that the loop 34 is angled proximal to the angled exits 44 to assume an alternative penetrating configuration.
  • the loop 34 is further retracted into the probe 20 such that only a minimum length of the loop 34 is outside of the probe 20 as determined by the distance between the angled exits 44.
  • the distance between the angled exits 44 is of sufficient length to prevent a kink or permanent deformity in the loop 34 when the loop 34 is retracted.
  • the probe 20 defines a groove 56 near the angled exits 44. The loop 34 (not shown) is positioned in the groove 56 when the loop 34 is retracted.
  • the retracted loop 34 may be positioned in a partial groove or in an opening in the probe.
  • the loop 34 is further extended by the loop controller 42 and is in a cutting configuration. Further extension of the loop 34 increases the size of and releases the loop 34 from the groove 38 which allows the loop 34 to move to the cutting configuration.
  • the change in the loop angle ⁇ when the loop 34 moves from the penetrating configuration to the cutting configuration is preferably facilitated by the superelastic properties of the metal or metal alloy of the electrode 30.
  • the loop angle ⁇ is approximately 90 degrees when the loop 34 is in the cutting configuration.
  • Cutting around a volume of soft tissue is accomplished by advancing and/or retracting the probe 20 when the loop 34 is in the cutting configuration. Extension and/or retraction of the loop 34 are preferably controlled by movement of one and/or both of the electrode ends 32.
  • the probe 20 and/or the loop 34 may contain a locating mechanism (not shown) to aid in determining the location of the probe 20 and/or the loop 34 within the tissue.
  • a detecting mechanism preferably located external to the tissue, detects the locating mechanism.
  • the locating mechanism may include radiologic or ultrasound markers, light or other signal emitters, or such other mechanism as may be detectable by the corresponding detecting mechanism typically external to the patient.
  • the cross-sectional area of the electrode 30 may be round, square, triangular, rectangular, oval, diamond-shaped, polygonal or any other desired shape.
  • One or more cutting edges on the loop 34 and/or electrode 30 may be sharpened or serrated.
  • the electrode 30 may be in continuity with an external energy source (not shown) such as but not limited to radio frequency energy, laser and/or vibration. Other methods of cutting soft tissue may be incorporated into the loop and/or electrode including but not limited to air abrasion and/or water jet.
  • an electrical circuit may be configured as a monopolar system with the loop acting as the active electrode and a larger, dispersive grounding pad acting as the return electrode.
  • the return electrode may be positioned on or near the cutting device 100 resulting in a bipolar system.
  • the loop 34 and/or electrode 30 may be partially or completely insulated to expose the radio frequency energy to the tissue at one or more predetermined locations on the loop 34.
  • Materials that may act as insulators include but are not limited to ceramics and polymers such as polymethylsiloxane, paratetrafluoroethylene, polyimide, and/or polyetheretherketone.
  • the loop 34 may oscillate along one or more predetermined directions to facilitate the cutting of soft tissue.
  • the loop 34 may oscillate by movement of the electrode 30 within the loop channels 26. In an alternative, the loop 34 may oscillate by movement of the probe 20.
  • the loop 34 may be energized during positioning of the probe 20 when the loop 34 is in the penetrating configuration.
  • the groove 38 is proximal to the distal end 22.
  • the distal end 22 is configured as a sharpened tip that may facilitate tissue penetration but the distal end 22 may be any number of configurations that preferably aid in tissue penetration such as a sharpened edge or edges.
  • the distal end 22 may also be energized, for example, with radio frequency energy and/or any other suitable energy.
  • the distal end 22 may contain one or more penetrators 66 that protrude distally as illustrated in the embodiment in FIG. 2B. The penetrator 66 may.
  • the penetrator 66 may be sharpened and/or may be energized with, for example, radio frequency energy to facilitate tissue penetration.
  • energizing of the distal end 22 or the penetrator 66 is independent from and electrically isolated from energizing of the electrode 30.
  • the penetrator 66 is partially or completely insulated to expose the radio frequency energy to the tissue at one or more predetermined locations on the penetrator 66.
  • the penetrator 66 may oscillate in one or more predetermined directions to facilitate penetration of the soft tissue.
  • a loop holder 60 is used to maintain the loop 34 in the penetrating configuration.
  • a holder end 62 of the loop holder 60 comprises a "Y" shaped configuration but any suitable configuration of the holder end 62 to facilitate maintaining the loop 34 in the penetrating configuration may be used.
  • the loop holder 60 may be retracted by a loop holder controller located on the handle (not shown), for example, such that the loop 34 is released from the holder end 62 and moves to the cutting configuration.
  • a loop cover 80 is configured at least partially around the probe 20 and moves along the probe axis 28. As illustrated in FIG.
  • the loop cover 80 is at or near the distal end 22 and positions the loop 34 in the penetrating configuration.
  • the loop cover 80 is moved along the probe axis 28 proximally toward the handle, the loop 34 is uncovered and no longer restricted by the loop cover 80 and moves to the cutting configuration as shown in FIG. 3D.
  • the loop cover 80 is preferably controlled by a loop cover controller (not shown) located on the handle, for example.
  • the cutting process is completed by retracting the loop 34 into the probe 20 and/or moving the loop cover 80 over the loop 34 to mechanically position the loop 34 into the penetrating configuration.
  • the loop cover 80 is moved along the probe axis 28 distally away from the handle to uncover the loop 34.
  • a fixed end 50 of the electrode 30 is located at or near the distal end 22 of the probe 20 and an electrode end (not shown) of the electrode 30 is located in the proximal end 24 of the probe 20 or in the handle (not shown).
  • the probe 20 contains a single loop channel 26 such that the probe 20 has a smaller profile (e.g., diameter) than where the probe contains multiple loop channels and/or provides more room within the probe 20 for the change in alignment of the loop channel 26 from being generally parallel to the probe axis 28 to terminating at the angled exit 44.
  • the increased room provides for a less acute change of direction, thereby facilitating movement of the electrode 30 within the loop channel 26.
  • an imaging catheter 70 is positioned within the probe 20 such that the imaging catheter 70 scans an imaging area adjacent to or containing the loop 34.
  • the exemplary embodiment shows the imaging catheter 70 in position to image an area containing the loop 34, but the imaging catheter 70 may be positioned in any suitable position along the probe 20.
  • the imaging catheter 70 may be configured to rotate about the probe axis 28 to broaden the imaging area.
  • the imaging catheter 70 is preferably an ultrasound transducer but may also be any other type of suitable imaging modality.
  • the ultrasound transducer preferably has a high frequency in a range between approximately 10 MHz to 100 MHz. The proximity of the ultrasound transducer to the imaged area provides for use of a higher frequency which gives improved resolution of the imaged area.
  • the imaging catheter 70 may acquire images that are processed to show at least a two-dimensional, a three-dimensional and/or a four-dimensional image.
  • the imaging catheter 70 may be employed during positioning of the probe 20 and/or during the cutting process (i.e., as the probe 20 is advanced or retracted with the loop 34 in the cutting configuration). Preferably the imaging catheter 70 images in real time the, loop 34 and the volume of soft tissue being excised during the cutting process. Preferably the imaging catheter 70 and the loop 34 are moved in unison as the probe 20 is advanced or retracted during the cutting process.
  • the imaging catheter 70 may be fixed within the probe 20 or preferably the imaging catheter 70 is configured as a separate component that slides into an imaging channel 72 contained in the probe 20. When advanced to the desired position in the imaging channel 72, the imaging catheter 70 is preferably secured in place with a lock mechanism (not shown).
  • the position of the imaging catheter 70 relative to the loop 34 may be predetermined or varied depending on the positioning of the imaging catheter 70 within the imaging channel 72.
  • the probe 20 and/or the loop 34 may additionally include an enhanced visualization mechanism using medical imaging such as radiologic or ultrasound markers or may include a signaling device to provide emitted signals to be detected by an external detector.
  • FIGS. 7A and 7B illustrate another embodiment of the cutting device.
  • the electrode 30 is completely contained within the probe 20 in the penetrating configuration.
  • the electrode 30 is shown extending out of the probe 20 in the cutting configuration.
  • the electrode 30 is advanced out of the probe 20 through the exit 54, located at or near the distal end 22, by an advancement controller located on the handle (not shown), for example.
  • the shape memory properties of the electrode 30 cause the loop 34 to assume a predetermined size and shape. Configuring the loop 34 to the predetermined size and shape is performed before the electrode is assembled into the cutting device and is well know to those skilled in the art.
  • the superelastic properties of the material allow the loop 34 to be entirely or almost entirely positioned within the probe 20 without creating a kink or permanent deformity in the loop 34.
  • the loop 34 may be energized with radio frequency energy, laser and/or vibration, for example, prior to and during advancement through the exit 54.
  • the loop may be partially or completely insulated to facilitate the cutting process. Oscillation of the loop may additionally or alternatively be applied to facilitate the cutting process.
  • FIGS. 8A-8D are schematics illustrating a cutting process using the cutting device 100 in an area of a breast 90.
  • the area of the breast 90 contains a nipple/areolar complex 99 and a lobe 97 containing a duct 96.
  • the duct 96 contains a lesion 94 and a disease extension 95 within the duct 96.
  • An imaging device 110 is preferably used to locate the duct 96, the lesion 94, and disease extension 95 and guide the cutting process.
  • the imaging device 110 is an ultrasound transducer although any other suitable imaging modality may be used.
  • the imaging device 110 may acquire images that are processed to give two-dimensional, three-dimensional and/or four-dimensional images.
  • the imaging catheter contained within the probe 20 as described above may be used alone or in conjunction with the imaging device 110 to guide the cutting process.
  • the probe 20 enters the breast 90 through a skin incision 98 that is preferably located at a border of the nipple/areola complex 99.
  • the probe 20 is positioned under the duct 96 and the lesion 94 but in various alternatives the probe 20 may be positioned on a side of or superficial to the duct 96 and/or lesion 94.
  • the distal end 22 is positioned distal to the lesion 94 and any additional disease within the duct 96 (i.e., the disease extension 95) relative to the skin incision 98.
  • the probe 20 is preferably positioned with the loop 34 in the penetrating configuration.
  • the loop 34 may be energized using, for example, an external radio frequency energy source (not shown) to facilitate tissue penetration and positioning of the probe 20.
  • FIG. 8B the loop 34 is energized and expanded into the cutting configuration.. Expansion releases the loop 34 from the groove 38 and energizing allows the loop 34 to cut through soft tissue as the loop 34 moves into the cutting configuration.
  • the height and width of the loop 34 may be adjusted or varied to ensure that the entire lesion 94 and disease extension 95 is encircled by the loop 34 during the cutting process.
  • the probe 20 is retracted as illustrated in FIG. 8C, causing the loop 34 to cut tissue circumferentially around the lesion 94 and the disease extension 95.
  • the imaging device 110 generally continues to keep the loop 34 and/or the area of tissue adjacent to the loop 34 within the imaging area. For example, if the imaging device 110 is an ultrasound transducer, the ultrasound transducer moves preferably in unison with the loop 34 to keep the loop 34 within the imaging area.
  • the loop 34 is proximal to the lesion 94 and the disease extension 95.
  • the loop 34 is retracted completing the cutting process. Once retracted, energizing of the loop 34 can be terminated.
  • the distal end of the probe 20 is positioned proximal to the lesion 94 and disease extension 95, the loop 34 is expanded and the probe 20 is advanced to accomplish the cutting process.
  • the loop 34 and/or probe 20 may be configured to oscillate or move back and forth in an independent motion that is separate from the advancement or retraction of the probe 20.
  • the independent motion enhances the cutting process.
  • the independent motion is along a direction defined by the curvature of the loop 34.
  • the independent motion is along any direction or combination of directions defined by the loop axis, the probe axis and/or a direction that is at one or more angles to the loop axis and the probe axis.
  • a tissue collector is attached to the loop and/or the probe.
  • the tissue collector preferably encompasses the severed tissue during the cutting process or after the cutting process is complete.
  • the tissue collector facilitates in removal of the cut tissue from the breast.
  • a tissue marking mechanism may be incorporated into the cutting device to facilitate orientation of the cut tissue after removal from the breast. The tissue marking mechanism marks the specimen during the cutting process and/or after the cutting process is complete.
  • a soft tissue orientation and imaging guide system may be incorporated to facilitate targeting of the area of soft tissue to be excised, orient and fixate the area of soft tissue during the cutting process and facilitate movement of the imaging scanner relative to the cutting device.
  • FIG. 9 is a flowchart illustrating a cutting process 200 employing the cutting device and using an imaging device to guide the procedure.
  • radiological imaging preferably axial ductal ultrasound scanning
  • the breast is identified a targeted volume of soft tissue that includes a lesion and the duct and/or lobe in which the lesion has developed.
  • the targeted tissue also includes any extension of the lesion or disease process (e.g., extension of disease within the duct, growth into Cooper's ligament and multifocal lesions).
  • the axial ductal ultrasound scanning is preferably performed prior to the cutting process 200 to delineate the lesion size, shape and position relative to the duct(s) and the lobe, and to identify disease extension within the duct(s), growth into Cooper's ligament and multifocal lesions.
  • the axial ductal ultrasound scanning may be enhanced with the use of ultrasound contrast agents, such as described in co-pending U.S. Patent Application No. 10/167,017, entitled "Ultrasound Imaging Of Breast Tissue Using Ultrasound Contrast Agent” and filed on June 11, 2002, the entirety of which is incorporated by reference herein.
  • the axial ductal ultrasound images may be processed to give images that are at least one of two-dimensional, three-dimensional and four-dimensional images.
  • the cutting device is inserted through a skin incision on the breast.
  • the incision is typically made in relatively close proximity to the targeted tissue being imaged.
  • the incision is made at the areolar border to provide for improved cosmesis.
  • the imaging and cutting process may be facilitated with the use of a soft tissue orientation and imaging guide system, such as that describe in co- pending U.S. Patent Application No. 10/284,990, entitled “Soft Tissue Orientation and Imaging Guide Systems and Methods" and filed on October 31, 2002, the entirety of which is incorporated by reference herein.
  • the cutting device preferably guided using the medical imaging, is positioned adjacent to the targeted tissue in preparation for the cutting process.
  • the targeted tissue includes the entire lesion and the diseased duct(s) containing any extension of the lesion, multifocal lesions, growth into Cooper's ligament or the entire lobe or part of the lobe containing the lesion.
  • the loop is held in the penetrating configuration to facilitate penetration into the soft tissue.
  • the loop may be energized from an external energy source such as a radio frequency generator.
  • the distal end of the probe is positioned distal to the targeted tissue relative to the skin incision.
  • the loop is energized and expanded which moves the loop from the penetrating configuration to the cutting configuration. As the loop moves to the cutting configuration, tissue is cut along the path of movement.
  • the loop is further expanded to increase the size of the loop such that the loop can create a circumferential cut around the targeted tissue.
  • the height and/or width of the loop is preferably adjusted before and/or during the cutting process.
  • the circumferential cut includes a satisfactory margin of normal tissue surrounding the lesion, the diseased ducts(s), growth into Cooper's ligament and/or multifocal lesions.
  • the probe is retracted which causes the loop to create a circumferential cut around the targeted tissue.
  • the loop and/or probe may oscillate or move in a back and forth in an independent motion that is separate from the advancement or retraction of the probe to facilitate the cutting process.
  • the imaging device images the loop and/or area of tissue adjacent to the loop during the cutting process.
  • the loop is retracted and energizing of the loop terminated, completing the cutting process 200.
  • a tissue collector may be employed to encompass the targeted tissue that has been cut to facilitate removal from the breast.
  • a tissue marking system may also be employed to facilitate orientation of the targeted tissue once removed from the breast.
  • the distal end of the probe is positioned proximal to the targeted tissue relative to the skin incision.
  • the probe is advanced causing the loop to create a circumferential cut around the targeted tissue.
  • the loop is retracted.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Pathology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Radiology & Medical Imaging (AREA)
  • Surgical Instruments (AREA)
  • Laser Surgery Devices (AREA)

Abstract

L'invention porte sur des dispositifs et sur des procédés de micromanipulation chirurgicale visant à inciser un tissu. Le dispositif comprend généralement une sonde pourvue d'un sortie distale au niveau d'un angle de sortie par rapport à la sonde, un circuit de découpe à mémoire de forme ayant une configuration prédéfinie et un mécanisme de fixation destiné à fixer le circuit de découpe sous une configuration de pénétration et à le libérer sous cette même configuration. Le circuit de découpe se trouve généralement à l'intérieur d'un profilé de la sonde sous la configuration de pénétration. Dans la configuration de découpe, le circuit d découpe s'étend dans la sortie et reprend généralement sa forme prédéfinie au niveau d'un angle de découpe généralement formé par l'angle de sortie. Le mécanisme de fixation du circuit de écope peut être, éventuellement, un couvercle pouvant coulisser sur la sonde, un élément coulissable s'étendant depuis un embout distal de la sonde ou une rainure formée dans la sonde proximale par rapport à la sortie du circuit de découpe.
PCT/US2004/005168 2003-02-20 2004-02-20 Dispositif d'incision pliable WO2004073524A1 (fr)

Priority Applications (4)

Application Number Priority Date Filing Date Title
DE602004022514T DE602004022514D1 (de) 2003-02-20 2004-02-20 Biegbare schneidevorrichtung
JP2006503767A JP2006518646A (ja) 2003-02-20 2004-02-20 屈曲可能な切断デバイス
AT04713390T ATE439089T1 (de) 2003-02-20 2004-02-20 Biegbare schneidevorrichtung
EP04713390A EP1599139B1 (fr) 2003-02-20 2004-02-20 Dispositif d'incision pliable

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US44906103P 2003-02-20 2003-02-20
US60/449,061 2003-02-20

Publications (1)

Publication Number Publication Date
WO2004073524A1 true WO2004073524A1 (fr) 2004-09-02

Family

ID=32908686

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2004/005168 WO2004073524A1 (fr) 2003-02-20 2004-02-20 Dispositif d'incision pliable

Country Status (6)

Country Link
US (1) US7229440B2 (fr)
EP (1) EP1599139B1 (fr)
JP (1) JP2006518646A (fr)
AT (1) ATE439089T1 (fr)
DE (1) DE602004022514D1 (fr)
WO (1) WO2004073524A1 (fr)

Cited By (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007016141A3 (fr) * 2005-07-27 2007-06-28 Spectranetics Corp Appareil de retrait de fil endocardiaque
WO2009062057A2 (fr) * 2007-11-07 2009-05-14 Mirabilis Medica Inc. Dispositif de création de tunnel par étincelles hémostatiques d'érosion tissulaire à traitement intégral assurant une nécrotisation volumétrique variable du tissu
US8052604B2 (en) 2007-07-31 2011-11-08 Mirabilis Medica Inc. Methods and apparatus for engagement and coupling of an intracavitory imaging and high intensity focused ultrasound probe
US8057391B2 (en) 2006-01-13 2011-11-15 Mirabilis Medica, Inc. Apparatus for delivering high intensity focused ultrasound energy to a treatment site internal to a patient's body
US8097012B2 (en) 2005-07-27 2012-01-17 The Spectranetics Corporation Endocardial lead removing apparatus
US8216161B2 (en) 2008-08-06 2012-07-10 Mirabilis Medica Inc. Optimization and feedback control of HIFU power deposition through the frequency analysis of backscattered HIFU signals
US8277379B2 (en) 2006-01-13 2012-10-02 Mirabilis Medica Inc. Methods and apparatus for the treatment of menometrorrhagia, endometrial pathology, and cervical neoplasia using high intensity focused ultrasound energy
US8439907B2 (en) 2007-11-07 2013-05-14 Mirabilis Medica Inc. Hemostatic tissue tunnel generator for inserting treatment apparatus into tissue of a patient
WO2013119970A1 (fr) * 2012-02-09 2013-08-15 Boston Scientific Scimed, Inc. Outil de coupe doté d'un fil circulant
US8845559B2 (en) 2008-10-03 2014-09-30 Mirabilis Medica Inc. Method and apparatus for treating tissues with HIFU
US9050449B2 (en) 2008-10-03 2015-06-09 Mirabilis Medica, Inc. System for treating a volume of tissue with high intensity focused ultrasound
US9248318B2 (en) 2008-08-06 2016-02-02 Mirabilis Medica Inc. Optimization and feedback control of HIFU power deposition through the analysis of detected signal characteristics
US10258792B2 (en) 2005-07-22 2019-04-16 The Spectranetics Corporation Endocardial lead cutting apparatus
US10869689B2 (en) 2017-05-03 2020-12-22 Medtronic Vascular, Inc. Tissue-removing catheter
US11357534B2 (en) 2018-11-16 2022-06-14 Medtronic Vascular, Inc. Catheter
US11690645B2 (en) 2017-05-03 2023-07-04 Medtronic Vascular, Inc. Tissue-removing catheter
US11819236B2 (en) 2019-05-17 2023-11-21 Medtronic Vascular, Inc. Tissue-removing catheter
US12114887B2 (en) 2021-07-02 2024-10-15 Medtronic Vascular, Inc. Tissue-removing catheter with guidewire isolation liner

Families Citing this family (88)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6036924A (en) 1997-12-04 2000-03-14 Hewlett-Packard Company Cassette of lancet cartridges for sampling blood
US6391005B1 (en) 1998-03-30 2002-05-21 Agilent Technologies, Inc. Apparatus and method for penetration with shaft having a sensor for sensing penetration depth
US8641644B2 (en) 2000-11-21 2014-02-04 Sanofi-Aventis Deutschland Gmbh Blood testing apparatus having a rotatable cartridge with multiple lancing elements and testing means
US7041068B2 (en) 2001-06-12 2006-05-09 Pelikan Technologies, Inc. Sampling module device and method
AU2002315177A1 (en) 2001-06-12 2002-12-23 Pelikan Technologies, Inc. Self optimizing lancing device with adaptation means to temporal variations in cutaneous properties
US9795747B2 (en) 2010-06-02 2017-10-24 Sanofi-Aventis Deutschland Gmbh Methods and apparatus for lancet actuation
US9226699B2 (en) 2002-04-19 2016-01-05 Sanofi-Aventis Deutschland Gmbh Body fluid sampling module with a continuous compression tissue interface surface
JP4149911B2 (ja) 2001-06-12 2008-09-17 ペリカン テクノロジーズ インコーポレイテッド 電気式ランセットアクチュエータ
US8337419B2 (en) 2002-04-19 2012-12-25 Sanofi-Aventis Deutschland Gmbh Tissue penetration device
US7344507B2 (en) 2002-04-19 2008-03-18 Pelikan Technologies, Inc. Method and apparatus for lancet actuation
WO2002100461A2 (fr) 2001-06-12 2002-12-19 Pelikan Technologies, Inc. Dispositif et procede permettant d'ameliorer le rendement du prelevement de sang capillaire au bout du doigt
AU2002312521A1 (en) 2001-06-12 2002-12-23 Pelikan Technologies, Inc. Blood sampling apparatus and method
WO2002100254A2 (fr) 2001-06-12 2002-12-19 Pelikan Technologies, Inc. Procede et appareil pour un dispositif de lancement de lancette integre sur une cartouche de prelevement de sang
US7981056B2 (en) 2002-04-19 2011-07-19 Pelikan Technologies, Inc. Methods and apparatus for lancet actuation
US9427532B2 (en) 2001-06-12 2016-08-30 Sanofi-Aventis Deutschland Gmbh Tissue penetration device
US7713214B2 (en) 2002-04-19 2010-05-11 Pelikan Technologies, Inc. Method and apparatus for a multi-use body fluid sampling device with optical analyte sensing
US8702624B2 (en) 2006-09-29 2014-04-22 Sanofi-Aventis Deutschland Gmbh Analyte measurement device with a single shot actuator
US8221334B2 (en) 2002-04-19 2012-07-17 Sanofi-Aventis Deutschland Gmbh Method and apparatus for penetrating tissue
US7909778B2 (en) 2002-04-19 2011-03-22 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US7291117B2 (en) 2002-04-19 2007-11-06 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US9795334B2 (en) 2002-04-19 2017-10-24 Sanofi-Aventis Deutschland Gmbh Method and apparatus for penetrating tissue
US7901362B2 (en) 2002-04-19 2011-03-08 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US7892183B2 (en) 2002-04-19 2011-02-22 Pelikan Technologies, Inc. Method and apparatus for body fluid sampling and analyte sensing
US7648468B2 (en) 2002-04-19 2010-01-19 Pelikon Technologies, Inc. Method and apparatus for penetrating tissue
US7232451B2 (en) 2002-04-19 2007-06-19 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US8784335B2 (en) 2002-04-19 2014-07-22 Sanofi-Aventis Deutschland Gmbh Body fluid sampling device with a capacitive sensor
US7491178B2 (en) 2002-04-19 2009-02-17 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US7547287B2 (en) 2002-04-19 2009-06-16 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US7371247B2 (en) 2002-04-19 2008-05-13 Pelikan Technologies, Inc Method and apparatus for penetrating tissue
US8267870B2 (en) 2002-04-19 2012-09-18 Sanofi-Aventis Deutschland Gmbh Method and apparatus for body fluid sampling with hybrid actuation
US7331931B2 (en) 2002-04-19 2008-02-19 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US8579831B2 (en) 2002-04-19 2013-11-12 Sanofi-Aventis Deutschland Gmbh Method and apparatus for penetrating tissue
US7674232B2 (en) 2002-04-19 2010-03-09 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US7229458B2 (en) 2002-04-19 2007-06-12 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US7976476B2 (en) 2002-04-19 2011-07-12 Pelikan Technologies, Inc. Device and method for variable speed lancet
US7717863B2 (en) 2002-04-19 2010-05-18 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US9248267B2 (en) 2002-04-19 2016-02-02 Sanofi-Aventis Deustchland Gmbh Tissue penetration device
US9314194B2 (en) 2002-04-19 2016-04-19 Sanofi-Aventis Deutschland Gmbh Tissue penetration device
US7297122B2 (en) 2002-04-19 2007-11-20 Pelikan Technologies, Inc. Method and apparatus for penetrating tissue
US8574895B2 (en) 2002-12-30 2013-11-05 Sanofi-Aventis Deutschland Gmbh Method and apparatus using optical techniques to measure analyte levels
EP1633235B1 (fr) 2003-06-06 2014-05-21 Sanofi-Aventis Deutschland GmbH Appareil d'echantillonnage de fluides anatomiques et d'examen de l'analysat
WO2006001797A1 (fr) 2004-06-14 2006-01-05 Pelikan Technologies, Inc. Element penetrant peu douloureux
US8282576B2 (en) 2003-09-29 2012-10-09 Sanofi-Aventis Deutschland Gmbh Method and apparatus for an improved sample capture device
EP1680014A4 (fr) 2003-10-14 2009-01-21 Pelikan Technologies Inc Procede et appareil fournissant une interface-utilisateur variable
US7822454B1 (en) 2005-01-03 2010-10-26 Pelikan Technologies, Inc. Fluid sampling device with improved analyte detecting member configuration
EP1706026B1 (fr) 2003-12-31 2017-03-01 Sanofi-Aventis Deutschland GmbH Procédé et appareil permettant d'améliorer le flux fluidique et le prélèvement d'échantillons
EP1751546A2 (fr) 2004-05-20 2007-02-14 Albatros Technologies GmbH & Co. KG Hydrogel imprimable pour biocapteurs
EP1765194A4 (fr) 2004-06-03 2010-09-29 Pelikan Technologies Inc Procede et appareil pour la fabrication d'un dispositif d'echantillonnage de liquides
WO2005120150A2 (fr) * 2004-06-07 2005-12-22 James Schellenberg Systeme et dispositif de microcatheter pour une imagerie medicale du sein
US8652831B2 (en) 2004-12-30 2014-02-18 Sanofi-Aventis Deutschland Gmbh Method and apparatus for analyte measurement test time
GB0601878D0 (en) * 2006-01-31 2006-03-08 Naser Waheeb Rotating Surgical Electrode (Naser's Electrode)
US7569053B2 (en) * 2006-03-03 2009-08-04 Intact Medical Corporation Apparatus for retrieving a tissue volume with improved positioning precursor assembly
JP4531735B2 (ja) * 2006-09-25 2010-08-25 Ｈｏｙａ株式会社 内視鏡用高周波切開具
US8298243B2 (en) 2007-07-30 2012-10-30 Tyco Healthcare Group Lp Combination wire electrode and tube electrode polypectomy device
JP5563485B2 (ja) 2008-01-31 2014-07-30 コヴィディエン リミテッド パートナーシップ ポリープ除去装置および使用方法
WO2009126900A1 (fr) 2008-04-11 2009-10-15 Pelikan Technologies, Inc. Procédé et appareil pour dispositif de détection d’analyte
US7869564B2 (en) * 2008-09-29 2011-01-11 Mir Medical Imaging Research Holding Gmbh X-ray machine for breast examination having a beam configuration for high resolution images
US9125720B2 (en) * 2008-10-13 2015-09-08 Alcon Research, Ltd. Capsularhexis device with flexible heating element
US9375169B2 (en) 2009-01-30 2016-06-28 Sanofi-Aventis Deutschland Gmbh Cam drive for managing disposable penetrating member actions with a single motor and motor and control system
US20100312273A1 (en) * 2009-06-03 2010-12-09 Kim Robert E Combined vascular and closure sheath
US8814854B2 (en) * 2009-06-03 2014-08-26 Alcon Research, Ltd. Capsulotomy repair device and method for capsulotomy repair
US20100312252A1 (en) * 2009-06-03 2010-12-09 Guangyao Jia Capsularhexis device with flexible heating element having an angled transitional neck
US8965476B2 (en) 2010-04-16 2015-02-24 Sanofi-Aventis Deutschland Gmbh Tissue penetration device
US9241755B2 (en) 2010-05-11 2016-01-26 Alcon Research, Ltd. Capsule polishing device and method for capsule polishing
DE102011079494A1 (de) 2011-07-20 2013-01-24 Celon Ag Medical Instruments Elektrochirurgisches Greifinstrument
US9314295B2 (en) * 2011-10-20 2016-04-19 Covidien Lp Dissection scissors on surgical device
US9381033B2 (en) * 2012-04-30 2016-07-05 Joseph Guo Method and apparatus for thread transection of a ligament
WO2014007380A1 (fr) * 2012-07-06 2014-01-09 国立大学法人鳥取大学 Aiguille pour biopsie et appareil endoscopique utilisant ladite aiguille pour biopsie
AU2014218734B2 (en) 2013-02-22 2018-03-15 Allosource Cartilage mosaic compositions and methods
USD707818S1 (en) 2013-03-05 2014-06-24 Alcon Research Ltd. Capsulorhexis handpiece
KR102138399B1 (ko) 2013-03-15 2020-07-27 알로소스 천공된 골연골 동종이식 조성물
EP2970882B1 (fr) 2013-03-15 2018-11-28 AlloSource Matrice de collagène repeuplée de cellules pour réparation et régénération des tissus mous
US9867636B2 (en) * 2013-03-15 2018-01-16 The Regents Of The University Of California Method, apparatus, and a system for a water jet
IN2013CH04514A (fr) * 2013-10-04 2015-04-10 Kennametal India Ltd
USD737438S1 (en) 2014-03-04 2015-08-25 Novartis Ag Capsulorhexis handpiece
BR112017005315B1 (pt) 2014-09-17 2023-04-11 Carl Zeiss Meditec Cataract Technology Inc Dispositivo cirúrgico para cortar uma lente dentro de um saco capsular de um olho
US9629747B2 (en) 2014-09-17 2017-04-25 Iantech, Inc. Devices and methods for cutting lenticular tissue
US10813685B2 (en) 2014-09-25 2020-10-27 Covidien Lp Single-handed operable surgical instrument including loop electrode with integrated pad electrode
DE102015102542A1 (de) * 2015-02-23 2016-08-25 medwork GmbH Endoskopische Schneideinrichtung zum Freischneiden einer mit einer Halteplatte versehenen Sonde
US10624785B2 (en) 2016-01-30 2020-04-21 Carl Zeiss Meditec Cataract Technology Inc. Devices and methods for ocular surgery
US20180153572A1 (en) * 2016-04-03 2018-06-07 Transit Scientific, LLC Apparatus and methods for retrieving objects from within the body of a subject
WO2017181142A1 (fr) 2016-04-14 2017-10-19 Brandner Theresa Dispositifs médicaux utilisant des alliages à mémoire de forme et systèmes et procédés associés
ES2939887T3 (es) 2016-10-26 2023-04-27 Zeiss Carl Meditec Inc Dispositivo para cortar un cristalino en un ojo
US20180280078A1 (en) * 2017-03-30 2018-10-04 Regents Of The University Of Minnesota Electrical surgical system for cutting or cauterizing tissue and a method of the same
KR102131399B1 (ko) * 2017-05-24 2020-07-08 고려대학교산학협력단 경비담관 배액관의 구강-비강 위치변경 장치
DE102017126199A1 (de) * 2017-11-09 2019-05-09 Rz-Medizintechnik Gmbh Chirurgisches Instrument mit einer Schlinge aus einem metallischen Draht
JP7312177B2 (ja) 2017-12-14 2023-07-20 カール・ツァイス・メディテック・キャタラクト・テクノロジー・インコーポレイテッド 眼科手術のための装置および方法
JP7161740B2 (ja) * 2018-03-30 2022-10-27 国立大学法人鳥取大学 生検針

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6068603A (en) * 1998-02-17 2000-05-30 Olympus Optical Co., Ltd. Medical instrument for use in combination with an endoscope
US20020072688A1 (en) * 1998-03-03 2002-06-13 Senorx, Inc. Breast biopsy system and methods
WO2002100286A1 (fr) * 2001-06-12 2002-12-19 Senorx, Inc. Dispositif et methode d'acces a des tissus et d'ancrage associe
US6500113B2 (en) * 1997-04-01 2002-12-31 George A. Vilos Debris aspirating resectoscope

Family Cites Families (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3739784A (en) * 1971-12-01 1973-06-19 Olympus Optical Co Surgical instrument
DE3247793C2 (de) * 1981-12-31 1986-01-09 Harald 7200 Tuttlingen Maslanka Hochfrequenz-chirurgische Schlingenelektrode
US5171233A (en) * 1990-04-25 1992-12-15 Microvena Corporation Snare-type probe
US5078716A (en) * 1990-05-11 1992-01-07 Doll Larry F Electrosurgical apparatus for resecting abnormal protruding growth
US5201741A (en) * 1990-07-24 1993-04-13 Andrew Surgical, Inc. Surgical snare with shape memory effect wire
US5192286A (en) * 1991-07-26 1993-03-09 Regents Of The University Of California Method and device for retrieving materials from body lumens
US5336227A (en) * 1991-11-05 1994-08-09 Wilk & Nakao Medical Technology Incorporated Surgical cauterization snare with polyp capturing web net
US5190542A (en) * 1991-11-05 1993-03-02 Nakao Naomi L Surgical retrieval assembly and related method
US5190555A (en) * 1991-12-13 1993-03-02 Unisurge, Inc. Device for collection and removal of body parts during laparoscopic surgery
US5415656A (en) * 1993-09-28 1995-05-16 American Medical Systems, Inc. Electrosurgical apparatus
JP3730757B2 (ja) * 1997-07-30 2006-01-05 オリンパス株式会社 内視鏡用処置具
US6608603B2 (en) * 2001-08-24 2003-08-19 Broadcom Corporation Active impedance matching in communications systems
US6743228B2 (en) * 2001-09-12 2004-06-01 Manoa Medical, Inc. Devices and methods for tissue severing and removal
US6730097B2 (en) * 2001-12-07 2004-05-04 William G. Dennis Surgical snare with steering tether and method of using same
US6852111B1 (en) * 2002-04-11 2005-02-08 David Lieber Laparoscopic electrotome

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6500113B2 (en) * 1997-04-01 2002-12-31 George A. Vilos Debris aspirating resectoscope
US6068603A (en) * 1998-02-17 2000-05-30 Olympus Optical Co., Ltd. Medical instrument for use in combination with an endoscope
US20020072688A1 (en) * 1998-03-03 2002-06-13 Senorx, Inc. Breast biopsy system and methods
WO2002100286A1 (fr) * 2001-06-12 2002-12-19 Senorx, Inc. Dispositif et methode d'acces a des tissus et d'ancrage associe

Cited By (30)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10258792B2 (en) 2005-07-22 2019-04-16 The Spectranetics Corporation Endocardial lead cutting apparatus
WO2007016141A3 (fr) * 2005-07-27 2007-06-28 Spectranetics Corp Appareil de retrait de fil endocardiaque
US7993359B1 (en) 2005-07-27 2011-08-09 The Spectrametics Corporation Endocardial lead removing apparatus
US8097012B2 (en) 2005-07-27 2012-01-17 The Spectranetics Corporation Endocardial lead removing apparatus
US8057391B2 (en) 2006-01-13 2011-11-15 Mirabilis Medica, Inc. Apparatus for delivering high intensity focused ultrasound energy to a treatment site internal to a patient's body
US8277379B2 (en) 2006-01-13 2012-10-02 Mirabilis Medica Inc. Methods and apparatus for the treatment of menometrorrhagia, endometrial pathology, and cervical neoplasia using high intensity focused ultrasound energy
US8052604B2 (en) 2007-07-31 2011-11-08 Mirabilis Medica Inc. Methods and apparatus for engagement and coupling of an intracavitory imaging and high intensity focused ultrasound probe
WO2009062057A2 (fr) * 2007-11-07 2009-05-14 Mirabilis Medica Inc. Dispositif de création de tunnel par étincelles hémostatiques d'érosion tissulaire à traitement intégral assurant une nécrotisation volumétrique variable du tissu
WO2009062057A3 (fr) * 2007-11-07 2009-08-06 Mirabilis Medica Inc Dispositif de création de tunnel par étincelles hémostatiques d'érosion tissulaire à traitement intégral assurant une nécrotisation volumétrique variable du tissu
US8187270B2 (en) 2007-11-07 2012-05-29 Mirabilis Medica Inc. Hemostatic spark erosion tissue tunnel generator with integral treatment providing variable volumetric necrotization of tissue
US8439907B2 (en) 2007-11-07 2013-05-14 Mirabilis Medica Inc. Hemostatic tissue tunnel generator for inserting treatment apparatus into tissue of a patient
US9248318B2 (en) 2008-08-06 2016-02-02 Mirabilis Medica Inc. Optimization and feedback control of HIFU power deposition through the analysis of detected signal characteristics
US10226646B2 (en) 2008-08-06 2019-03-12 Mirabillis Medica, Inc. Optimization and feedback control of HIFU power deposition through the analysis of detected signal characteristics
US8216161B2 (en) 2008-08-06 2012-07-10 Mirabilis Medica Inc. Optimization and feedback control of HIFU power deposition through the frequency analysis of backscattered HIFU signals
US8845559B2 (en) 2008-10-03 2014-09-30 Mirabilis Medica Inc. Method and apparatus for treating tissues with HIFU
US9050449B2 (en) 2008-10-03 2015-06-09 Mirabilis Medica, Inc. System for treating a volume of tissue with high intensity focused ultrasound
US9770605B2 (en) 2008-10-03 2017-09-26 Mirabilis Medica, Inc. System for treating a volume of tissue with high intensity focused ultrasound
WO2013119970A1 (fr) * 2012-02-09 2013-08-15 Boston Scientific Scimed, Inc. Outil de coupe doté d'un fil circulant
US9463059B2 (en) 2012-02-09 2016-10-11 Boston Scientific Scimed, Inc. Cutting tool with circulating wire
US10925632B2 (en) 2017-05-03 2021-02-23 Medtronic Vascular, Inc. Tissue-removing catheter
US10869689B2 (en) 2017-05-03 2020-12-22 Medtronic Vascular, Inc. Tissue-removing catheter
US10987126B2 (en) 2017-05-03 2021-04-27 Medtronic Vascular, Inc. Tissue-removing catheter with guidewire isolation liner
US11051842B2 (en) 2017-05-03 2021-07-06 Medtronic Vascular, Inc. Tissue-removing catheter with guidewire isolation liner
US11690645B2 (en) 2017-05-03 2023-07-04 Medtronic Vascular, Inc. Tissue-removing catheter
US11871958B2 (en) 2017-05-03 2024-01-16 Medtronic Vascular, Inc. Tissue-removing catheter with guidewire isolation liner
US11896260B2 (en) 2017-05-03 2024-02-13 Medtronic Vascular, Inc. Tissue-removing catheter
US11986207B2 (en) 2017-05-03 2024-05-21 Medtronic Vascular, Inc. Tissue-removing catheter with guidewire isolation liner
US11357534B2 (en) 2018-11-16 2022-06-14 Medtronic Vascular, Inc. Catheter
US11819236B2 (en) 2019-05-17 2023-11-21 Medtronic Vascular, Inc. Tissue-removing catheter
US12114887B2 (en) 2021-07-02 2024-10-15 Medtronic Vascular, Inc. Tissue-removing catheter with guidewire isolation liner

Also Published As

Publication number Publication date
JP2006518646A (ja) 2006-08-17
US20040220564A1 (en) 2004-11-04
DE602004022514D1 (de) 2009-09-24
US7229440B2 (en) 2007-06-12
EP1599139A1 (fr) 2005-11-30
ATE439089T1 (de) 2009-08-15
EP1599139B1 (fr) 2009-08-12

Similar Documents

Publication Publication Date Title
US7229440B2 (en) Bendable cutting device
EP1432360B1 (fr) Dispositifs de separation et d'elimination de tissus
US7377902B2 (en) Biopsy anchor device with cutter
US20050228403A1 (en) Tissue cutting devices and methods
AU2001295188B2 (en) Excisional biopsy devices and methods
US6569176B2 (en) Device and method for improved diagnosis and treatment of cancer
US6471709B1 (en) Expandable ring percutaneous tissue removal device
US7303531B2 (en) Excisional biopsy devices and methods
EP1960053B1 (fr) Systeme de suivi d'une ablation aux rayons
AU2001295188A1 (en) Excisional biopsy devices and methods
US20120083653A1 (en) Guided procedural treatment device and method

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BW BY BZ CA CH CN CO CR CU CZ DE DK DM DZ EC EE EG ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NA NI NO NZ OM PG PH PL PT RO RU SC SD SE SG SK SL SY TJ TM TN TR TT TZ UA UG US UZ VC VN YU ZA ZM ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): BW GH GM KE LS MW MZ SD SL SZ TZ UG ZM ZW AM AZ BY KG KZ MD RU TJ TM AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IT LU MC NL PT RO SE SI SK TR BF BJ CF CG CI CM GA GN GQ GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
WWE Wipo information: entry into national phase

Ref document number: 2006503767

Country of ref document: JP

WWE Wipo information: entry into national phase

Ref document number: 2004713390

Country of ref document: EP

WWP Wipo information: published in national office

Ref document number: 2004713390

Country of ref document: EP